Provider Demographics
NPI:1174616866
Name:BETHLEHEM INFECTIOUS DISEASES ASSOCIATES LLC
Entity type:Organization
Organization Name:BETHLEHEM INFECTIOUS DISEASES ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THONG
Authorized Official - Middle Name:P
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-954-4000
Mailing Address - Street 1:PO BOX 3667
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-0667
Mailing Address - Country:US
Mailing Address - Phone:610-289-2980
Mailing Address - Fax:610-289-2990
Practice Address - Street 1:801 OSTRUM STREET
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:610-954-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016472400001Medicaid
PA1016472400001Medicaid